Question:
I have been denied by BCBS of AL they say I don't have the comorbidities for surgery

BMI 38. AGE 42. Current Health Problems: lupus, intractable pain, 5 back surgeries, degenerative disk disease, HTN, asthma, stress incontinence, UTI's, joint pain, pitting edema, menstrual irreg, stroke, TIA (mini-stroke), GERD, high cholesterol, short of breath, low thyroid, arthritis, heart murmur,I also have migraines, family history of obesity, cancer, and heart disease. I am getting ready to appeal, but want to have all my ducks in a row first. Should I call and speak to someone in person? I live in TX, but ins. is through husbands home company in AL. I was told that I might be able to try going through BCBS of TX, can I do this, think I'd have any luck? I really do need some help here. Thanks    — Denise F. (posted on January 11, 2004)

January 11, 2004
Did the insurance company give you a specific reason they denied the surgery? I've read where it's been denied because a wrong code was submitted which will be easy to correct, do you have the specifics on why they denied you?
   — Shayna T.

January 11, 2004
It really depends on how your doctor presented the request to the insurance company. A BMI of 38 is considered SERVERLY OBESE not MORBIDLY OBESE. Before trying to switch insurances I would appeal the decision.
   — jcooper

January 11, 2004
Denise, Have you considered self-paying? You might want to check out Dr. Baltasar in Spain or Dr. Marchesini in Brazil. Both have Yahoo groups - if you go to www.groups.yahoo.com and do a search for the last name of either you'll find the group. Or, you can also check out www.bodybybaltasar.com Blessings, dina
   — Dina McBride

January 11, 2004
Here is a helpful article that might give you ideas for your appeal. Scroll to the section that reads "Patient Selection." This is from the American Bariatric Surgeons Association website. http://www.asbs.org/html/rationale/rationale.html
   — Shayna T.

January 11, 2004
I would see how it was write up because I have bcbs al and my bmi was around 38 and I didnt have as many thing as you the only thing that I really had was greds and I was aproved the 1st time with a week are so. I had a revision and it was aproved also. So you need to see how it was writen up.
   — maxine84

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